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This content is taken from the Maudsley Learning & The Tavistock and Portman NHS Foundation Trust's online course, COVID-19: Psychological Impact, Wellbeing and Mental Health. Join the course to learn more.

Skip to 0 minutes and 0 seconds Well, it seems like life does continue if I miss work. I’ve been off for a week now. I got a temperature on the ward and straight away I was put into a mask, sent for a swab and then immediately sent home. I didn’t even get a chance to say goodbye which is needed I suppose. The next day the results came through and sure enough it was positive for Covid.

Skip to 0 minutes and 31 seconds One night is really bad? But I know I got it easy compared to some. It’s not just the illness, though. It’s that once I stopped, everything else hit me as well. I was a state I was crying. I was hopeless and now I’m just exhausted. Can’t even imagine being at work. At first I wanted to try to go to the online meetings, but then I realised I just need to step away. My team must know me so well because they texted to say don’t even think about joining in online. And they’re right? My manager is covering my role temporarily, which is good, but I do feel a bit guilty about that.

Skip to 1 minute and 16 seconds But when I was in bed yesterday, I counted up all the hours I did last week and it was a lot. I guess it’s just not sustainable.

Skip to 1 minute and 35 seconds But what is becoming more clear is that African and Caribbean and Asian staff are more likely to die of Covid, which is really scary. They don’t know what to do about it at work, but they are talking about it now, which is good and the trust of set up online meetings for us to raise our concerns. I haven’t attended any yet, but I intend to when I get back because this needs to get sorted. I know we’re being given free food, which is great and local restaurants have been really generous.

Skip to 2 minutes and 19 seconds So generous, I mean, I wasn’t quite sure what to do with 100 Donuts, but anyway, and management of checking in on us more and you know, be more supportive making sure that we get in regular breaks, but we just need more equipment. We haven’t run out yet, but we were close a few times, and it’s just…

Skip to 2 minutes and 42 seconds Yeah, sorry.

Skip to 2 minutes and 45 seconds OK.

Skip to 2 minutes and 48 seconds He heard me. He said I need to rest. He’s been so good. Passing him food, but I am making sure that he wears gloves whenever he touches anything I’ve used because I’m worried about passing it to my son.

Skip to 3 minutes and 6 seconds I miss him so much. Just. Just want to give him a cuddle, you know? But maybe soon.

Coping as a key worker during COVID-19

Let’s think about Carol’s dilemma, and what key workers such as her can try to keep in mind in the coming weeks.

Sadly, we can see that Carol has fallen ill. But notice also that she said that ”life continues…”. This was partly a joke, no doubt, but for many of us in the care professions, switching out of carer mode can feel like a big deal, and can be something we avoid doing.

Let’s make clear at the outset that teams and services have a central role to play in looking after their staff; we’ll hear about this in the coming steps when we discuss the concepts of psychological first aid and containment.

Many factors can prevent teams and systems offering care and support to staff:

  • An economic agenda that prioritises outcomes and targets over staff wellbeing.
  • No allotted resource or time for supervision and respite.
  • A healthcare economy where agency/non-permanent staff are heavily drawn upon without the same staff benefits or team cohesion that regular salaried staff might experience.

This needs to be front and centre when thinking about looking after staff. But there are also things at the level of the individual that are worth noticing.

Let’s focus for a moment on what Carol has been struggling with individually.

Why might caring for others be easier than caring for ourselves? Why was it hard to stop, and why does it remain hard for Carol to remain calm when talking about this, even as she is supposed to be resting?

You’ve heard the focus of Carol’s worries: her family, her team, and her concerns for BAME colleagues’ all feature. Carol has a clear idea of what care, fairness, and justice look like, but tends to locate the need for care first and foremost in those she sees as more vulnerable than herself. This is a noble pursuit, but in individuals who adopt this role we need to watch out for the gradual depletion of internal stocks that eventually leads to what’s commonly called “burnout”.

There is a reason why the phrase, “fit your own oxygen mask first” has to be written in red letters on safety cards: many parents will instinctively not do this. Those in caring roles can have a similar dilemma.

It is important not to generalise, but something that Carol might want to watch out for in herself in the coming weeks is a feeling of guilt.

Guilt is that horrid, gnawing, or sinking feeling that many of us get if we think those around us aren’t cared for or looked after, or that we’ve done something wrong by not playing our role. It’s closely aligned with excessive responsibility.

Not all of us experience this to the same extent. Some of us, including many carers, can experience it a great deal.

Remember the call to notice our states of mind? Well, if a sense of guilt is the only thing that is preventing us from taking our foot off the accelerator, it might be important to reflect on this. It may feel like high levels of expectation to deliver dutiful care beyond what we are capable of comes entirely from our managers and teams, but there may be an internal block that also stops us from letting go of excessive responsibility.

You also heard Carol say that when she stopped, everything caught up with her, including the recent loss of her auntie. We may not always notice that when we are going full throttle, travelling to and fro, and complaining about how busy we are, that there may actually be something worse: not being busy. Stopping.

Thankfully, Carol is managing okay – but you heard her describe how much everything else hit her when she did stop. This is a common experience. A week, a month, a career’s worth of going above and beyond, followed by a collapse as we face the sometimes far more complicated task of attending to our own needs and vulnerabilities.

We have heard how in the coming months when the crisis abates this may be the time to look after carers. This may be the time that they also need to notice in themselves the need for care.

Soon we’ll hear more about the concepts of grievance and moral injury. These come from feeling that we are giving resources that we do not have, or are unable to offer the care we should due to constraints in a way that feels unfair.

It is important that key workers, and those around them, remain attuned to their own needs in the coming months. This is important so that the feelings of depletion are not exacerbated more than they have to be during a crisis, in which key workers are being pushed to the limit.

Once we find a state of mind where our own care can be prioritised, the rest follows. The number of resources for self-soothing and psychological first aid - eating well, sleeping, and exercise, gaining comfort, out to loved ones - is endless. See our external links in the final Week 2 step for just a few. First, however, we must recognise that like those we care for, we are also vulnerable and entitled to care.

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This video is from the free online course:

COVID-19: Psychological Impact, Wellbeing and Mental Health

Maudsley Learning